Skin toxicity after radiotherapy. About a case

A 60-year-old woman was admitted to the Department complaining of a slow growing mass in the right knee. Physical examination demonstrated a mass on the postero-lateral aspect of the right knee, which was not tender or mobile, however was rubbery and hard in consistency. Full flexion and extension was observed without any restriction of joint movement

Effectiveness of Climbing Lanes for Slow-Moving Vehicles When Riding Uphill: A Microsimulation Study

Long uphill stretches of single-carriageway rural roads with one lane per travel direction may reduce the Level of Service (LoS), due to the decreased speed of heavy vehicles. In those circumstances, a slowdown of traffic, resulting in the formation of platoons, may be generated due to the difficulty of performing overtaking maneuvers safely. To solve this critical issue, an additional (climbing) lane for slow vehicles may be included in the road platform. This study aims to evaluate the effectiveness of such climbing lanes in a real case in Italy (National Road n. 4 “Via Salaria”— around 44+000 km). Using a microsimulation model implemented in VISSIM, the study analyzes speeds and travel times, delays, and queuing waiting times, comparing the Actual Scenario (AS) without climbing lanes, with two counterfactual scenarios: the first one (CS1) with three stretches of climbing lanes, and the second one (CS2), with just two stretches, in which the first two additional lanes of CS1 are merged together. The obtained results confirm the effectiveness of installing climbing lanes on road sections with the described characteristics, and the potential of microsimulation models also to carry out such kind of evaluations

Thyroid ultrasonography reporting: consensus of Italian Thyroid Association (AIT), Italian Society of Endocrinology (SIE), Italian Society of Ultrasonography in Medicine and Biology (SIUMB) and Ultrasound Chapter of Italian Society of Medical Radiology (SIRM)

Thyroid ultrasonography (US) is the gold standard for thyroid imaging and its widespread use is due to an optimal spatial resolution for superficial anatomic structures, a low cost and the lack of health risks. Thyroid US is a pivotal tool for the diagnosis and follow-up of autoimmune thyroid diseases, for assessing nodule size and echostructure and defining the risk of malignancy in thyroid nodules. The main limitation of US is the poor reproducibility, due to the variable experience of the operators and the different performance and settings of the equipments. Aim of this consensus statement is to standardize the report of thyroid US through the definition of common minimum requirements and a correct terminology. US patterns of autoimmune thyroid diseases are defined. US signs of malignancy in thyroid nodules are classified and scored in each nodule. We also propose a simplified nodule risk stratification, based on the predictive value of each US sign, classified and scored according to the strength of association with malignancy, but also to the estimated reproducibility among different operators

Unusual Skin Toxicity after a Chemotherapic Combination

As known calciphylaxis (CPX) is a rare condition involving subcutaneous vascular calcification and cutaneous necrosis, mostly observed in patients with renal failure. However CPX may also appear in patients affected by polymyositis, Sjogren syndrome, Lupus Erythematosus systemicus, Sarcoidosis and rheumatoid arthritis, especially in children. Clinically CPX can present itself as subcutaneous nodules, infiltrate plaques or purpuric-like and livedo-like plaques, while in the late stages necrotic ulcers (with a bizarre shape and severe pain) may be the main cutaneous manifestations

A Challenging Nodular Lesion of the Ear

Skin nodular lesion are really frequent, but rapidly growing ones needs to be quickly removed since they can hide really aggressive skin tumor. Among malignant lesion Merkel cell carcinoma arise. It is a rare neuroendocrine skin tumor highly aggressive, not easy to diagnose at first stage, since at first diagnosis it is already widespreading all over the body. In order to renew interest in this letal skin tumori is mandatory to remind high risk population which include elderly people, white skin, chronically exposed to UV immunocompromised. Our unhappy case was described to increase awareness on this kind of skin tumor, since new drug appeared in the market can give an hope to these patients

Patient and physician satisfaction in an observational study with methyl aminolevulinate daylight-photodynamic therapy in the treatment of multiple actinic keratoses of the face and scalp in 6 European countries

BACKGROUND Guidelines recommend treating actinic keratoses (AKs) as they are recognized as precursors of invasive squamous cell carcinoma. OBJECTIVE The objective of this study was to collect real-world clinical data on the use of methyl aminolevulinate daylight photodynamic therapy (MAL DL-PDT) for the treatment of face and scalp AK in Europe. METHODS A prospective, multicenter, non-interventional study was conducted in six European countries in patients receiving a single treatment of MAL DL-PDT for face and/or scalp AK. Patient-reported outcomes were assessed by patient questionnaires at baseline and at 3 months after treatment, efficacy was assessed at 3 months using a 6-point global improvement scale, and adverse events (AE) were recorded at each visit. RESULTS Overall, 325 patients were enrolled from 52 investigational centres, 314 of whom attended the 3-month visit. Most patients had multiple lesions (58.4% had >10 lesions) with lesions mainly located on the scalp (60.0%) and/or forehead (54.2%). AKs were predominantly grade I (39.4%) or grade II (33.2%), and 10.5% of patients had grade III lesions. The proportions of patients and physicians that were overall satisfied to very satisfied with the MAL DL-PDT treatment were 80.4% and 90.3%, respectively. The vast majority of patients (90.0%) would consider using MAL DL-PDT again if needed. Physician-assessed efficacy at 3 months was at least much improved in 83.5% of patients, with 45.9% of patients requiring no retreatment. Related AEs were reported in 15% of patients. CONCLUSION Use of MAL DL-PDT for multiple face and/or scalp AKs resulted in high levels of patient and physician satisfaction in clinical practice in Europe, reflecting the good efficacy and high tolerability of this convenient procedure

Prevalência e incidência da hepatite C em pacientes submetidos a transplante renal

OBJECTIVE: To detect the prevalence and the seroconversion of the anti-HCV in renal transplants, while evaluating the presence of this antibody at the time of thetransplant, and during a 1-year follow-up, as well as the possibility of transmitting the disease to the recipient of the contaminated organ.PATIENTS AND METHODS: We investigated the prevalence of anti-HCV infection in 48 kidney transplant recipients, and also in their respective donors. Serumspecimens were collected from the organ recipients right before kidney transplant, and 6 and 12 months after transplant; serum specimens were collected from donors at the time of nephroctomy. The 192 samples were stored at -20º C. The anti-HCV tests used were commercial kits based on synthetic HCV peptides (UBI), enzygnost anti-HCV (Boehringer), and Abbot HCV EIA 2nd generation. In patients with a positive anti-hepatitis C UBI test, the presence of HCV-RNA was verified by polymerase chain reaction .RESULTS: Eleven of 40 patients had positive UBI results, and 12 of 48 had positive EIA anti-HCV results before the transplant. Sixteen patients were anti-HCV positive during the 1-year follow-up. Two patients became positive after 6 months, and one after 12 months. One of these patients was also HCV-RNA positive. No transplant recipient patient with positive anti-HCV before transplant seroconverted after 1 year. Fifty percent of the patients who received a kidney were HCV-RNA positive. Three of 40 donors indicated a positive anti-HCV antibody in the UBI test, and 4 of 48 donors indicated a positive anti-HCV antibody in the Boehringer and EIA tests. Two donors were HCV-RNA positive.CONCLUSIONS: The prevalence of anti-HCV before transplant was high, and the serconversion to positive was low during the follow-up; none of the anti-HCV positive patients seroconverted; the HCV-RNA positive patients did not change to negative after transplant, which indicates the persistence of viral replication even after immunosupression; anti-HCV positive donors, even in the presence of HCV-RNA, did not transmit the infection during 1 year after transplant.OBJETIVO: Investigar a prevalência do anti-VHC em 48 receptores renais e seusrespectivos doadores.PACIENTES E MÉTODOS: Foi coletado sangue dos receptores pré-transplante, 6meses e 1 ano pós-transplante; e dos doadores, no momento da nefrectomia. As192 amostras foram conservadas a -20 °C. Os testes anti-VHC utilizados forampeptídeos sintéticos (UBI) e ELISA de segunda geração (Abbott). Nos pacientescom positividade ao anti-VHC pelo teste UBI, foi pesquisado o VHC-ARN por reaçãoem cadeia da polimerase.RESULTADOS: Onze de 40 receptores foram anti-VHC positivos pelo teste da UBIe 12 de 48 pelo teste da Abbott pré-transplante. Dezesseis pacientes apresentarampositividade ao anti-VHC no período de 1 ano pós-operatório. Dois positivaram aos6 meses e um em 1 ano. Um deles apresentou positividade também ao VHC-ARN.Nenhum paciente anti-VHC positivo seroconverteu com 1 ano de seguimento.Verificou-se a presença do VHC-ARN em 50% dos receptores renais. Três de 40doadores foram anti-VHC positivos pelo teste UBI e 4 de 48 pelo teste Abbott. Doisdoadores apresentaram positividade ao VHC-ARN.CONCLUSÕES: 1) A prevalência do anti-VHC pré-transplante foi alta, porém aseroconversão para anti-VHC positivo no seguimento de 1 ano foi baixa; 2) nenhumpaciente anti-VHC positivo seroconverteu; 3) houve manutenção da positividadeao VHC-ARN demonstrando persistência da replicação viral apesar daimunossupressão; 4) os doadores anti-VHC positivos, mesmo com a presença doVHC-ARN não transmitiram a infecção através do enxerto renal no seguimento de1 ano pós-operatório

Ancient encaustic: An experimental exploration of technology, ageing behaviour and approaches to analytical investigation

The composition of the ancient wax-based painting technique known as encaustic has long been the subject of debate. Ancient sources provide few details of the technology, and modern understanding of the medium is restricted to theoretical interpretation and experimental observation. In this multi-analytical collaborative study, a number of analytical approaches were used to investigate the physical and molecular properties of a range of experimentally prepared encaustic paints before and after ageing. Analysis using gas chromatography mass spectrometry, Fourier transform infrared spectroscopy (invasive and non-invasive), X-ray diffraction and thermogravimetric analysis demonstrated how differences in the technology of production alter the properties and composition of the medium and showed how these are modified by the addition of pigment and the effects of ageing. Comparison of results from the different analytical techniques highlights the benefit of an integrated analytical approach to the analysis of ancient encaustic paints and the fundamental importance of insights from invasive study to evaluating the results of non-invasive analysis

EFSUMB Statement on Medical Student Education in Ultrasound [long version]

Publisher Copyright: © 2016 Georg Thieme Verlag. All rights reserved.The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) recommends that ultrasound should be used systematically as an easy accessible and instructive educational tool in the curriculum of modern medical schools. Medical students should acquire theoretical knowledge of the modality and hands-on training should be implemented and adhere to evidence-based principles. In this paper we report EFSUMB policy statements on medical student education in ultrasound that in a short version is already published in Ultraschall in der Medizin 1.publishersversionPeer reviewe

Minimally-invasive treatments for benign thyroid nodules: recommendations for information to patients and referring physicians by the Italian Minimally-Invasive Treatments of the Thyroid group

Purpose: In this paper, the members of the Italian Working Group on Minimally-Invasive Treatments of the Thyroid (MITT group) aim to summarize the most relevant information that could be of help to referring physicians and that should be provided to patients when considering the use of MITT for the treatment of benign thyroid nodules. Methods: An interdisciplinary board of physicians with specific expertise in the management of thyroid nodules was appointed by the Italian MITT Group. A systematic literature search was performed, and an evidence-based approach was used, including also the knowledge and the practical experience of the panelists to develop the paper. Results: The paper provides a list of questions that are frequently asked by patients to operators performing MITT, each with a brief and detailed answer and more relevant literature references to be consulted. Conclusions: This paper summarizes the most relevant information to be provided to patients and general practitioners/referring physicians about the use of MITT for the treatment of benign thyroid nodules